<?
$page_title="Registration Form - Retreat 2012-13  ";
$mindex=5;
?>
<? include("includes/header.php") ?>
<style type="text/css">
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color:#000;
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<form action="reg_retreat.php?m=1" method="post" onsubmit="return checkrequired(this)">
<div class="section">



<b>Retreat Dates :</b> Thu 27th evening Fri 28th -Sat 29th -Sunday 30th morning December,2012   <br/>
<b>Baba Milan Date :</b> Monday 31st December,2012
<div class="fright"><a href="retreat_detail.php">more info</a>
</div>
</div>

<div class="section">
<p>
<b>1.Please write your BKITC Membership No : </b><br/><b>BKITC</b> <input name="membership_no" size="20" maxlength="32" type="text" onkeypress="return allowNumbersOnly(event)"/> (e.g 5 digit number) 00263
</p>
<p>
<b>2.Have you attended any 'BK India IT Meetings/Retreats' earlier </b>? If Yes, <br/>

please write when (in which year/s) and where (place/s), you have attended   <input name="last_attended_info" size="60" maxlength="40" type="text" />

</p>
<hr/>
<table id="Regform" border="0" cellspacing="3" cellpadding="4">
<tbody>



	<tr>

		<td width="25%">Your First Name:<span>* </span> BK</td>

		<td width="25%"><input name="firstname" size="20" maxlength="32" type="text" /></td>

		<td width="20%">Last Name:<span>*</span></td>

		<td width="25%"><input name="lastname" size="20" maxlength="32" type="text" /></td>

	</tr>

	<tr>

		<td>Sister / Brother:<span>*</span></td>

		<td colspan="3">
        <select size="1" name="gender">
     	<option value="Brother">Brother</option>
        <option value="Sister">Sister</option>
      
        </select>
        </td>

	</tr>

	<tr>

		<td>Current Profession:<span>*</span></td>

		<td colspan="3"><input name="profession" size="20" maxlength="64" type="text" /></td>

	</tr>

	<tr>

		<td>Your Skills:<span>*</span></td>

		<td colspan="3"><input name="skills" size="30" maxlength="64" type="text" /></td>

	</tr>

	<tr>

		<td>Number of years working as an IT Professional:<span>*</span></td>

		<td colspan="3"><input name="yr_it" size="5" maxlength="2" type="text" onkeypress="return allowNumbersOnly(event)" /></td>

	</tr>



	<tr>

		<td>Your Email address:<span>*</span></td>

		<td><input name="email" size="20" maxlength="64" type="text" /></td>

		

	</tr>

	<tr>

		<td>Phone: ( incl STD code) / Mobile Nos</td>

		<td><input name="telephone" size="20" maxlength="16" type="text" /></td>
		<td valign="top">Your Current Address with State<span>*</span></td>

		<td valign="top"><textarea name="current_address"  ></textarea></td>

		

	</tr>

	<tr>

		<td>Number of years in Gyan:<span>*</span></td>

		<td ><input name="yr_gyan" size="5" maxlength="2" type="text"  onkeypress="return allowNumbersOnly(event)"/></td>

		<td>Name of your BK Centre Incharge:<span>*</span> </td>

		<td>BK <input name="centre_incharge" size="30" maxlength="64" type="text" /></td>

		

	</tr>

	<tr>

		<td valign="top">Address of your BK Centre with State:<span>*</span></td>
		<td valign="top"><textarea name="centre_name"  ></textarea></td>
		
		<td>Your BK Centre's Email address:<span></span></td>

		<td><input name="centre_email" size="20" maxlength="64" type="text" /></td>
		

	</tr>

	<tr>
		<td>BK Centre's Telephone (Incl STD code):</td>

		<td><input name="centre_telephone" size="20" maxlength="16" type="text" /></td>
		<td>Your BK Centre's zone:</td>

		<td><input name="centre_zone" size="20" maxlength="64" type="text" /></td>

	</tr>

	
	
	<tr>

		<td>Have you UPDATED your '<a href="profile.php">My Profile</a>': YES/No. If No, ...?<span>*</span></td>

		<td ><input name="profile_status" size="20"  type="text"  /></td>

		<td>Have you UPLOADED your <a href="profile.php">CV/Resume</a> in your 'My Profile':  YES/No. If No, ...?
<span>*</span> </td>

		<td><input name="resume_status" size="20"  type="text" /></td>
	</tr>
	
	
	<tr>

		<td valign="top">Have you served OR serving any BKITC Project? If Yes, write about the Project & your Contributions<span>*</span></td>

		<td valign="top"><textarea name="serving_remarks"  ></textarea></td>

		<td valign="top">Are you interested in serving any BKITC Project? If Yes, write about the Project with your Role/ Contributions
<span>*</span> </td>

		<td valign="top"><textarea name="interest_remarks"  ></textarea></td>

		

	</tr>
	<tr>

		<td colspan="2">&nbsp;</td>

		<td colspan="2">&nbsp;</td>

	</tr>

	<tr>

		<td colspan="2">Ways in which you have used or will use your IT skills/ background for spiritual service / for the yagya:</td>

		<td colspan="2" valign="top"><textarea rows="4" name="spiritual_service" cols="30"></textarea></td>

	</tr>

	<tr>

		<td colspan="2">What would you expect from this IT Retreat to provide for you?

		<p style="padding:0px;margin:0px">
		OR Any other information you want to share :
		 </p>
		</td>

		<td colspan="2"><textarea rows="4" name="meeting_purpose" cols="30"></textarea></td>

	</tr>

	<tr>

		<td colspan="4">
			
        <fieldset>
		<legend>SKILLS based "Sevadhari Interest Groups (SIGs)" for Remote or/and Madhuban Service  </legend>
				
        <table style="margin: 10px 0pt 0pt 5px;" width="95%">

		  <tbody>

				  <tr>

					<th class="projects" align="left" width="35%">Sevadhari Interest Groups (SIGs) Names</th>

					<th align="center" width="15%">Involved in</th>

					<th align="center">Would like to be involved</th>

				  </tr>

				  <tr>

					<td> Project Management Office (PMO)</td>

					<td align="center"><input value="true" name="involved_pmo" type="checkbox" /></td>

					<td align="center"><input value="true" name="interest_pmo" type="checkbox" /></td>

				  </tr>
				    <tr>

					<td>Collaboration Tools</td>

					<td align="center"><input value="true" name="involved_collaboration" type="checkbox" /></td>

					<td align="center"><input value="true" name="interest_collaboration" type="checkbox" /></td>

				  </tr>
				  

				
				  <tr>

					<td>IT Infrastructure</td>

					<td align="center"><input value="true" name="involved_itinfra" type="checkbox" /></td>

					<td align="center"><input value="true" name="interest_itinfra" type="checkbox" /></td>

				  </tr>

				  <tr>

					<td>Application Development</td>

					<td align="center"><input value="true" name="involved_appdev" type="checkbox" /></td>

					<td align="center"><input value="true" name="interest_appdev" type="checkbox" /></td>

				  </tr>
				    <tr>

					<td>Websites</td>

					<td align="center"><input value="true" name="involved_website" type="checkbox" /></td>

					<td align="center"><input value="true" name="interest_website" type="checkbox" /></td>

				  </tr>


				  <tr>

					<td>Multimedia</td>

					<td align="center"><input value="true" name="involved_multimedia" type="checkbox" /></td>

					<td align="center"><input value="true" name="interest_multimedia" type="checkbox" /></td>

				  </tr>

				  <tr>

					<td>IT Industry Service  & Research</td>

					<td align="center"><input value="true" name="involved_itservice" type="checkbox" /></td>

					<td align="center"><input value="true" name="interest_itservice" type="checkbox" /></td>

				  </tr>

				  <tr>

					<td>IT Help Desk Hardware / Software</td>

					<td align="center"><input value="true" name="involved_helpdesk" type="checkbox" /></td>

					<td align="center"><input value="true" name="interest_helpdesk" type="checkbox" /></td>

				  </tr>
				  <tr>

					<td>Communications</td>

					<td align="center"><input value="true" name="involved_communications" type="checkbox" /></td>

					<td align="center"><input value="true" name="interest_communications" type="checkbox" /></td>

				  </tr>
				
          </tbody>
        </table>

			</fieldset>

		</td>

	</tr>

	<tr>

		<td colspan="4">&nbsp;</td>

	</tr>

	<tr>

		<td colspan="4">
		
        <p align="center"><input value="  Submit  " name="submit" type="submit" />&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
		<input value="  Reset  " name="reset" type="reset" /></p>
        </td>

	</tr>

	
    </tbody>
  </table>

  </div>

</form>



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<? include("includes/footer.php") ?>